1. Field of the Invention
This invention relates to surgical suturing procedures and, more particularly, to a device for delivering a pre-tied suture assembly into a body cavity, as during a laparoscopic procedure. The device can also be utilized to assist needle transfer and repositioning during suturing. The invention is further directed to a method of a) delivering a suture into a cavity using the inventive structure and b) assisting the suture tying process.
2. Background Art
Various techniques are known for delivering sutures into a body cavity during laparoscopy. By one method, a conventional forceps is utilized. If the user grabs the needle on the suture with the forceps jaws and draws the suture in a trailing direction, there is a risk that the exposed part of the needle may snag as it is being introduced to the body cavity or, alternatively, that the rigidly held needle may puncture an organ within the cavity, once introduced thereinto.
Alternatively, the user can grip the suture thread and pull the needle through in a trailing direction. While this obviates the problem of organ puncture, it introduces an additional problem. A substantial force must be applied by the jaws of the forceps on the thread to draw the needle into the cavity without fear of the suture's dislodging from the forceps. The gripping action of the jaws on the suture may cause fraying of the suture or a localized weakening which could result in a failure of the suture during the tying process.
It is also known to pre-tie a loop in a suture before the suture and needle are introduced into a body cavity. This loop acts as a noose to facilitate the tying of the first knot by the user. The loop/noose diameter is diminished by drawing on the suture thread while holding any part of the noose/loop stationary. If the pre-tied suture is introduced to a body cavity by grasping the suture, other than at the loop/noose and by drawing the suture structure into the cavity, as with a forceps, there is a tendency of the loop/noose diameter to diminish and possibly completely close, which is obviously undesirable.
The above problems would still be encountered if one were to surround the trailing body of a forceps with the loop/noose and grasp the thread and/or needle with the forceps forwardly thereof in directing the suture into the body cavity. If the loop/noose is drawn too tightly around the forceps body, the user would have to work the loop/noose loose to free the suture from the instrument once the same is in the body cavity. If the loop/noose is too large, it could slide uncontrollably along the forceps body and over the jaws thereon during introduction to prematurely separate entirely from the instrument.
A still further problem encountered in suturing during laparoscopy is that of manipulating the suturing needle once the suture is within the cavity. Various instruments have been devised for positively gripping a needle and for allowing the needle to be driven through adjacent tissue edges to initiate a knot, which is cinched to close an incision. Once the first instrument drives the needle through the tissue, the needle must be released, repositioned and resituated in that same instrument. In the transition between the gripping and re-gripping of the needle, the needle may dangle freely from the suture protruding from the tissue. By one technique, the user can use the same instrument to try to re-grip the needle. The difficulties with this are aggravated by the lack of suitable instruments available to readily accomplish this. One known instrument, for example, has a slot on one side thereof in which the needle must be located to effect holding thereof. The user must often blindly try to guide the dangling needle into that opening, which can be very inconvenient and time consuming.
Alternatively, a forceps-type instrument can be introduced into the body cavity solely for the purpose of holding the needle in a transition position and assisting the relocation of the needle in the device which is used to drive it through the tissue. The difficulty with this is that proper orientation of the needle is seldom achieved with the use of existing instruments, which often require gripping and regripping of the needle several times until proper orientation of the needle in the needle driver is obtained. Further, the user may be required to constantly remove and insert different instruments as various procedures are being performed.